[The cost of surgical and endovascular treatment of abdominal aortic aneurysm - a retrospective comparative study]. / Náklady na chirurgickú a endovaskulárnu liecbu aneuryzmy brusnej aorty - retrospektívna komparatívna stúdia.

INTRODUCTION: A comparison of the costs of a surgery and an endovascular treatment of abdominal aortic aneurysms (AAA) for the General Health Insurance Company (VsZP) in 2009-2010. MATERIAL AND METHODS: Between 2009 and 2010, VsZP paid for treatment of 211 patients with AAA with an average age of 69 years (range: 41-91 years). Out of these, 174 patients underwent surgical treatment and 37 patients were treated by endovascular means. In both groups, we observed a total cost of treatment, payment for hospitalization (UH) and separately charged material (ZM), the cost of blood and reimbursement for CT (computer tomography) examinations and the patient age. For statistical comparison, we used the nonparametric Mann-Whitney U test, the limit of statistical significance was <0.01. The data were processed and compared by means of contingency tables in MS Excel and then statistically processed in the program StatSoft, Inc.. (2011). STATISTICA (data analysis software system), version 10th www.statsoft.com. RESULTS: The total two-year costs of VsZP for the treatment of AAA were € 1 212 188 - out of which 37% were represented by the OR costs (open repair) and 63% for EVAR (endovascular aneurysm repair) (p <0.01). In terms of the ZM use (p <0.01), and the use of CT examinations (p <0.01), EVAR is cost demanding. OR is cost demanding in terms of the blood consumption levels (p <0.01). The average total cost per admission was € 21,038 for EVAR and € 2,493 for OR, representing only 12% of the total EVAR costs. The age of patients has no impact on the costs (p> 0.01). The decisive impact on the total costs is represented by ZM, which presents 90 % of costs of EVAR method and 44% of OR method. CONCLUSION: OR and EVAR are effective modalities for the treatment of AAA. EVAR is a minimally invasive method, but the treatment costs are more than 8 times higher than the costs of surgical treatment. In terms of the VsZP cost control for the treatment of AAA, there must be clearly defined explicit indication criteria for EVAR. In terms of the costs for the treatment of AAA with "good risk" patients and those cases where there are no local obstacles for the surgical treatment (eg, colostoma, hostile abdomen, ren arcuatus and other), the surgical therapy is a "gold" standard. The health insurance company is a crucial regulator of the system of payment for provided medical care. The development of medical technology and the financial burden, on one hand, and the limited and scarce resources, on the other hand, are a source of "tension" between the health care providers and the regulators (insurance, Ministry of Health). One way to slow the "opening of the scissors" is to establish clear rules for the entry of new technologies into clinical practice, clearly defined costs (COI - cost of illness), and the usefulness and cost-effectiveness (CEA - cost-effectiveness analysis, ICER - incremental cost-effectiveness ratio, QALY - quality-adjusted life year). Despite the fact that it has beenmore than 20 years after the "velvet revolution", implementing the principles of health economics and health technology into practice has been managed in a rather weak way. The comparison of the costs of treatment is applicable in many areas of clinical medicine, and in the case of well-defined data it can be a source for the determination of ICER, CEA and QALYs. Key words: abdominal aortic aneurysms - surgery and endovascular treatment - costs.

Histopathological autoptic findings in 8 patients with pandemic influenza A (H1N1) pneumonia.

UNLABELLED: In the years 2009 and 2010 a novel influenza A (H1N1) caused the first influenza pandemic after 41 years. In the Czech Republic it culminated in November and December 2009 and there were 101 laboratory-confirmed deaths. Another few cases occurred later in the year 2010 and at the beginning of 2011. Here we report 8 autoptic cases of patients who died between 2009 and 2011 with confirmed H1N1 influenza and underwent a post mortem examination at the Institute of Pathology, General University Hospital in Prague, Czech Republic. This group differs from the others reported in literature by having a higher age as well as a higher percentage of patients with pre-existing severe comorbidities including malignant diseases. All 8 patients developed atypical pneumonia with subsequent respiratory failure. In this article we present these cases with related clinical data and findings in other organs, but we focus primarily on the findings in the respiratory tract which were shown to be approximately similar to those in the other studies and case reports. Nevertheless there were also some noteworthy variations. The most prominent feature observed was diffuse alveolar damage accompanied by intraalveolar haemorrhage and inflammatory infiltrate of variable extent. Less frequent features included cytopathic changes of pneumocytes and their desquamation, reactive changes of bronchial epithelium, intraalveolar fibrinous exudate, minor necroses, residual necrotizing bronchitis, focal granulation tissue and incipient fibrosis. In one case we found an extraordinary vascular change of uncertain origin. In conclusion, this group of patients is slightly atypical and differ in some features from those in other published studies and case reports concerning novel pandemic influenza. By reporting them we wish to extend the number of described cases, which may contribute to a better understanding of the pathogenesis of novel influenza infection. KEYWORDS: influenza A virus, subtype H1N1 - viral pneumonia - diffuse alveolar damage.

[Primary tumors of the duodenum and the small intestine in our clinical study subjects over a ten-year period]. / Primárne tumory dvanástorníka a tenkého creva v nasom klinickom materiáli za desat'rocné obdobie.

The authors are evaluating occurrence of primary tumors of duodenum and small intestine during last 10 years (1995-2004) as a retrospective study. 13 patients were operated in this period, three of them are presented as case reports. The main clinical symptoms were bleeding and obstruction, two patients had no symptoms. To define the preoperative diagnosis of this kind of tumors is difficult and needs an essential combination of exams.